Christmas Campaign Application Form – Frenkel Topping Charitable Foundation

Step 1

Your details

Step 2

Nominee details

Step 3

Family details

Step 4

Consent

Name of Person making the application*

Relationship to the Beneficiary*

Email address*

Telephone number*

Are you part or connected to a larger organisation?*

Yes No

Please provide details of family member with severe injury/illness/medical condition

Name*

DOB*

Details of injury/illness/medical condition*

Financial situation (please provide details of whether parents are working) The affected individual and their family must be unable to support themselves financially*

Why do you feel we should consider your family for our Christmas Campaign*

Family Details

Name of Mum*

Name of Dad*

Family Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please provide the name, DOB and gender of each child

Name

DOB

Gender

Is the family happy to be identified or would they prefer to remail anonymous*

We are happy to be identified We would prefer to remaining anonymous

Would the family be happy for us to take and share photos/video footage*

Yes No

Consent

Please complete so that we can process your application

I consent to the processing of sensitive personal data as far as it is necessary for the services I require from Frenkel Topping Charitable Foundation*

From time to time, we may wish to contact you to offer additional products or services which may be of interest to you. In order to do this, we require your consent by agreeing to one or all of the options: I/we consent to be contacted for marketing purposes by:

Email Telephone Text message Post

Where did you hear about our campaign?*

What gift would your child like?*

Which local supermarket do you shop at?*

Christmas Campaign Application Form - 2025

Please provide details of family member with severe injury/illness/medical condition

Family Details

Consent

Are you sure you want to exit your application?